Meta Information
ID:magnesium-citrate
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/condition/renal-impairment
Target name:
Renal Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Impaired kidney function reduces the body's ability to excrete excess magnesium, creating a high risk of accumulation and toxicity (hypermagnesemia).
Actionable advice:
Magnesium supplements should not be used by those with kidney disease unless specifically prescribed and monitored by a doctor.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Here we detail her clinical course, including the unique challenges of treating eclampsia and PRES in the setting of magnesium toxicity.
Label source:
PubMed: Posterior Reversible Encephalopathy Syndrome and Eclampsia in the Setting of Magnesium Toxicity: A Case Report. (PMID 37948545)
Action type:
avoid
Target id:
/class/chelating-antibiotics
Target name:
Chelating Antibiotics (Tetracyclines, Quinolones)
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
4
Description:
Magnesium binds to tetracycline and fluoroquinolone antibiotics in the gut, forming an insoluble complex that prevents the absorption of both the drug and the mineral.
Actionable advice:
Magnesium should be taken at least 2 hours before or 4 hours after these antibiotics.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
However, when administered orally, reduced absorption and bioavailability can occur due to chelation in the gastrointestinal tract (GIT) with multivalent metal cations acquired from diet, coadministered compounds (sucralfate, didanosine), or drug formulation.
Label source:
PubMed: Pharmaceutics (2021)
Source url:
Exact phrase from label:
magnesium, calcium, and zinc can interfere with the gastrointestinal absorption of tetracycline antibiotics
Label source:
PubMed: International journal of molecular sciences (2019)
Source url:
Exact phrase from label:
the absorption of all quinolones appears to be significantly reduced by antacids containing magnesium and/or aluminum, and concomitant administration must be avoided. Other cations, such as calcium, iron, and probably zinc, appear to interact in a similar manner. Chelation between the quinolone and cation is the most likely mechanism.
Label source:
PubMed: The American journal of medicine (1989)
Action type:
separate
Target id:
/intervention/bisphosphonates
Target name:
Bisphosphonates
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Magnesium can significantly reduce the absorption of bisphosphonate drugs (for osteoporosis) by binding to them in the digestive tract.
Actionable advice:
Magnesium doses and bisphosphonates should be separated by at least 2 hours.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Instruct patients to take supplemental calcium and vitamin D if their dietary intake is inadequate; and to take calcium supplements, antacids, magnesium-based supplements or laxatives, and iron preparations at a different time of the day
Label source:
FDA label: Risedronate (Actonel)
Action type:
separate
Target id:
/intervention/levothyroxine
Target name:
Levothyroxine
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
4
Hours after target:
4
Description:
Magnesium ions can bind to levothyroxine, forming a poorly absorbed complex and reducing the effectiveness of thyroid hormone replacement.
Actionable advice:
Magnesium and levothyroxine doses should be separated by at least 4 hours.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Sucralfate, antacids and Antacids proton pump inhibitors may cause hypochlorhydria, affect (e.g., aluminum & magnesium intragastric pH, and reduce levothyroxine absorption.
Label source:
FDA label: Levothyroxine (Synthroid)
Action type:
separate
Target id:
/condition/myasthenia-gravis
Target name:
Myasthenia Gravis
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium can inhibit the release of acetylcholine at the neuromuscular junction, which can exacerbate muscle weakness in individuals with myasthenia gravis.
Actionable advice:
Magnesium supplements should not be used by those with myasthenia gravis.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Magnesium is known to act at the neuromuscular junction by inhibiting the presynaptic release of acetylcholine and desensitizing the postsynaptic membrane. Because of these effects, magnesium has been postulated to potentiate neuromuscular weakness.
Label source:
PubMed: Texas Heart Institute journal (2015)
Source url:
Exact phrase from label:
In MG patients, magnesium is contraindicated as it inhibits acetylcholine release, worsening muscle weakness and risking respiratory failure.
Label source:
PubMed: Harefuah (2026)
Source url:
Exact phrase from label:
Although paralysis after magnesium administration has been described in patients with known myasthenia gravis, it has not previously been reported to be the initial or only manifestation of the disease. Patients who are unusually sensitive to the neuromuscular effects of magnesium should be suspected of having an underlying disorder of neuromuscular transmission.
Label source:
PubMed: Muscle & nerve (1990)
Action type:
avoid
Target id:
/class/chelating-minerals
Target name:
Other Divalent Minerals (Iron, Zinc, Calcium)
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
High doses of magnesium can compete with other minerals like iron, zinc, and calcium for the same absorption pathways in the intestine.
Actionable advice:
High-dose magnesium and iron, zinc, or calcium supplements should be separated by at least 2 hours.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
The interaction between Fe, Ca, and Mg with other trace elements is orchestrated by some key proteins, especially DMT1 and DCYTB. The former has been implicated in the intestinal transport of Fe, Cu, Zn, and Cd, whereas the latter is able to change the oxidation state of both Fe and Cu ions
Label source:
Action type:
separate
Target id:
/class/potassium-sparing-diuretics
Target name:
Potassium-Sparing Diuretics
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Potassium-sparing diuretics (e.g., spironolactone, amiloride) can reduce the excretion of magnesium, potentially leading to high magnesium levels (hypermagnesemia) when combined with supplements.
Actionable advice:
Caution is warranted, and magnesium levels should be monitored, when combining with potassium-sparing diuretics.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
K-sparing diuretics are usually administered concomitantly with more potent diuretics to counteract diuretic-induced K depletion. These agents act in the late distal tubule and collecting duct. Evidence has accumulated in recent years indicating that these drugs may also exert some Mg-sparing properties.
Label source:
PubMed: Magnesium (1986)
Source url:
Exact phrase from label:
Potassium-sparing diuretics such as amiloride can be administered concomitantly with more potent diuretics to counteract diuretic-induced potassium depletion. Amiloride may also exert magnesium-sparing actions.
Label source:
PubMed: Magnesium (1984)
Source url:
Exact phrase from label:
Spironolactone promotes magnesium and potassium retention, increases uptake of myocardial norepinephrine, attenuates formation of myocardial fibrosis, and decreases mortality associated with both progressive ventricular dysfunction and malignant ventricular arrhythmias.
Label source:
PubMed: Current hypertension reports (2000)
Action type:
monitor
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium can relax blood vessels and lower blood pressure, potentially enhancing the effects of antihypertensive medications and increasing the risk of hypotension (low blood pressure).
Actionable advice:
Blood pressure should be monitored when starting high-dose magnesium alongside blood pressure medications.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Mg supplementation at a median dose of 368 mg/d for a median duration of 3 months significantly reduced systolic BP by 2.00 mm Hg (95% confidence interval, 0.43-3.58) and diastolic BP by 1.78 mm Hg (95% confidence interval, 0.73-2.82); these reductions were accompanied by 0.05 mmol/L (95% confidence interval, 0.03, 0.07) elevation of serum Mg compared with placebo.
Label source:
PubMed: Hypertension (Dallas, Tex. : 1979) (2016)
Source url:
Exact phrase from label:
The combination of increased intake of magnesium and potassium coupled with reduced sodium intake is more effective in reducing BP than single mineral intake and is often as effective as one antihypertensive drug in treating hypertension. Reducing intracellular sodium and calcium while increasing intracellular magnesium and potassium improves BP response. Magnesium also increases the effectiveness of all antihypertensive drug classes.
Label source:
PubMed: Journal of clinical hypertension (Greenwich, Conn.) (2011)
Source url:
Exact phrase from label:
Small changes in magnesium levels may have significant effects on cardiac excitability and on vascular tone, contractility and reactivity. Accordingly magnesium may be important in the physiological regulation of blood pressure whereas perturbations in cellular magnesium homeostasis could play a role in pathophysiological processes underlying blood pressure elevation.
Label source:
PubMed: Molecular aspects of medicine (2003)
Action type:
monitor
Target id:
/class/calcium-channel-blockers
Target name:
Calcium Channel Blockers
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium acts as a physiological calcium channel blocker, and its effects can be additive with these drugs, increasing the risk of low blood pressure or slow heart rate.
Actionable advice:
Caution is warranted, and it is worth monitoring for dizziness or low blood pressure, when combining with calcium channel blockers.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
For current labeling information, please visit https://www.fda.gov/drugsatfda
11 DESCRIPTION
NORVASC is the besylate salt of amlodipine, a long-acting calcium channel blocker.
Label source:
Action type:
monitor
Target id:
/class/proton-pump-inhibitors
Target name:
Proton Pump Inhibitors
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Chronic use of proton pump inhibitors (PPIs) can significantly impair magnesium absorption from the gut, leading to a risk of deficiency over time.
Actionable advice:
If you are on long-term PPI therapy, regular monitoring of magnesium levels and potential supplementation is recommended.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
• Proton pump inhibitors (PPIs), including PRILOSEC, are contraindicated in patients receiving rilpivirine-containing products [see Drug Interactions (7)].
Label source:
Action type:
monitor
Target id:
/class/diuretics
Target name:
Magnesium-Wasting Diuretics (Loop & Thiazide)
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Loop diuretics (e.g., furosemide) and thiazide diuretics (e.g., hydrochlorothiazide) increase the excretion of magnesium by the kidneys, which can lead to deficiency.
Actionable advice:
If taking these diuretics long-term, magnesium supplementation is often necessary to maintain adequate levels.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The effects of diuretics on renal handling of potassium and magnesium can result in depletion of these electrolytes.
Label source:
PubMed: Diuretics and potassium/magnesium depletion. Directions for treatment. (PMID 3551599)
Action type:
informational_none
Target id:
/intervention/vitamin-d
Target name:
Vitamin D
Severity:
moderate
Interaction type:
requirement
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Adequate Vitamin D levels are necessary for the active transport and absorption of magnesium in the gut. Magnesium is also required to activate Vitamin D.
Actionable advice:
Sufficient Vitamin D levels are a good idea for optimal magnesium utilization.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Serum vitamin D levels significantly increased only in the Mg group.
Label source:
PubMed: Magnesium citrate supplementation decreased blood pressure and HbA1c in normomagnesemic subjects with metabolic syndrome: a 12-week, placebo-controlled, double-blinded pilot trial. (PMID 34859788)
Action type:
informational_none
Target id:
/condition/diarrhea-prone
Target name:
Tendency for Diarrhea or IBS-D
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium citrate is an osmotic laxative that draws water into the intestines, which can cause or worsen diarrhea, especially in susceptible individuals.
Actionable advice:
If you have IBS-D or are prone to loose stools, consider a different form of magnesium, like glycinate or malate.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Magnesium citrate is another saline cathartic that often is used to cleanse the bowel before VC. This agent causes fluid to accumulate in the bowel because of its osmotic effects and promotes peristaltic activity and bowel emptying.
Label source:
Action type:
informational_none
Target id:
/condition/dehydration
Target name:
Dehydration
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The laxative effect of magnesium citrate draws water into the bowels, which can contribute to or worsen dehydration if fluid intake is not adequate.
Actionable advice:
It is a good idea to drink plenty of fluids when taking magnesium citrate to avoid dehydration.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Exact phrase from label:
Magnesium citrate is another saline cathartic that often is used to cleanse the bowel before VC. This agent causes fluid to accumulate in the bowel because of its osmotic effects and promotes peristaltic activity and bowel emptying.
Label source:
Action type:
avoid
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
moderate
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
2
Description:
Magnesium supplements can reduce the absorption of digoxin from the gut, while low magnesium levels in the body can increase the risk of digoxin toxicity.
Actionable advice:
Magnesium and digoxin doses should be separated by at least 2 hours, and adequate magnesium levels should be maintained.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
8.11 Malabsorption
The absorption of digoxin is reduced in some malabsorption conditions such as chronic diarrhea.
Label source:
Action type:
separate
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
informational
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking magnesium citrate with food can slow its transit through the gut, which may reduce the common side effect of diarrhea and potentially improve absorption.
Actionable advice:
Magnesium citrate is generally best taken with a meal to enhance tolerance.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
However, when magnesium salts were provided with meals there were more prominent increases in urinary magnesium (by 92 to 96 mg. per day) and in citrate (by 218 to 226 mg. per day). Moreover, urinary oxalate decreased.
Label source:
PubMed: The Journal of urology (1990)
Source url:
Exact phrase from label:
Our study also showed that, compared to the other Mg sources tested, the Mg-MS microencapsulation technology reduced adverse side effects commonly associated with Mg supplementation, specifically with regard to increased intestinal motility and sensations of gastric heaviness following oral administration.
Label source:
PubMed: Nutrients (2024)
Source url:
Exact phrase from label:
In principle, the relative Mg2+ uptake is higher when the mineral is in-gested in multiple low doses throughout the day compared to a single, large intake of Mg2+.
Label source:
PubMed: Current nutrition and food science (2017)
Action type:
informational_none
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
0
Description:
Magnesium plays a role in regulating neurotransmitters that promote calm and sleep, and may help improve sleep quality by supporting the parasympathetic nervous system.
Actionable advice:
Consider taking your magnesium dose about an hour before bedtime to support relaxation.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Magnesium not only reduces the excitability of the nervous system and alters muscle relaxation but also regulates cellular biological clocks, energy balance, and circadian rhythms, playing a crucial role in sleep regulation.
Label source:
PubMed: Nature and science of sleep (2025)
Source url:
Exact phrase from label:
The natural N-methyl-D-aspartic acid (NMDA) antagonist and GABA agonist, Mg(2+), seems to play a key role in the regulation of sleep.
Label source:
PubMed: Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences (2012)
Source url:
Exact phrase from label:
omega-3 fatty acids, magnesium, dietary fiber, promote autonomic balance by reducing sympathetic tone and enhancing parasympathetic function.
Label source:
PubMed: Folia medica Cracoviensia (2025)
Action type:
separate
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium may improve insulin sensitivity and glucose control, which can enhance the effects of diabetes medications and slightly increase the risk of low blood sugar (hypoglycemia).
Actionable advice:
It is a good idea to check blood glucose levels when starting magnesium supplementation while on diabetes medication.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.
Label source:
Action type:
monitor
Target id:
/class/benzodiazepines
Target name:
Benzodiazepines and other CNS Depressants
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Magnesium has mild central nervous system depressant effects that could be additive with medications like benzodiazepines, potentially increasing drowsiness or sedation.
Actionable advice:
Increased sedation may occur when combining magnesium with CNS depressant medications.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The anxiolytic-like effect of magnesium (20 mg/kg) was antagonized by flumazenil (10 mg/kg) (benzodiazepine receptor antagonist) while combined treatment with the non-effective doses of magnesium (10 mg/kg) and benzodiazepines (diazepam (0.5 mg/kg) or chlordiazepoxide (2 mg/kg)) produced synergistic interaction (increased time in open arms and number of open arm entries) in this test. The obtained data indicate that benzodiazepine receptors are involved in the anxiolytic-like effects of magnesium.
Label source:
Action type:
informational_none
Target id:
/dietary/phytate-rich-foods
Target name:
High-Phytate/Oxalate Foods (e.g., whole grains, legumes, spinach)
Severity:
minor
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Phytates and oxalates found in certain plant-based foods can bind to magnesium in the gut, slightly reducing its absorption when consumed at the same time.
Actionable advice:
For optimal absorption, taking magnesium away from meals very high in fiber, whole grains, or raw spinach may help.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Dietary factors impairing Mg2+ up-take include high doses of other minerals, partly fermentable fibres (e.g., hemicellulose), non-fermentable fibres (e.g., cellulose, lignin), phytate and oxalate, whereas proteins, medium-chain-triglycerides, and low- or indigestible carbohydrates (e.g., resistant starch, oligosaccharides, inulin, mannitol and lactulose) enhance Mg2+ uptake.
Label source:
PubMed: Current nutrition and food science (2017)
Source url:
Exact phrase from label:
Increased intakes of protein and fructose improve apparent magnesium absorption (magnesium intake minus fecal excretion) in humans, whereas a lowering effect occurs with consumption of cellulose and phytate.
Label source:
PubMed: Progress in food & nutrition science (1992)
Source url:
Exact phrase from label:
Phytate binds avidly to and can reduce gastrointestinal absorption of the phosphate anion and many macrominerals and trace elements including iron, zinc, calcium, and magnesium.
Label source:
PubMed: Clinical journal of the American Society of Nephrology : CJASN (2024)
Action type:
separate